CONCEPT OF SHADKRIYAKAALA OF VRANA BY SUSRUTHA W.S.R TO VENOUS ULCER

Acharya Susrutha has described about the Samprapthi (pathogenesis) of Vrana (ulcer) in detail in Susrutha samhitha sutrasthana. All the ulcers like arterial ulcer, venous ulcer, trophic ulcer etc can be considered as Vrana. But no specific term has been made by Acharya for venous ulcer. Venous ulcers are the wounds occurring as a result of inappropriate functioning of venous valves or of venous obstruction by thrombus. While going through the characteristics of Dushtavrana (chronic ulcer) like Krishna/ Suklavarna (hyper/hypopigmented areas), Deerghakaala anubandhitwa (chronicity), Durgandhitha pooyasraava (foul smelling serous/ purulent discharge) etc, venous ulcer can be considered as a dushtavrana, particularly in its chronic stage. Sira (vein) is the deranged anatomical component in case of venous insufficiency as well as venous ulcer and this Sira has been told as one of the Vranasthaanaas (sites of Vrana) by Susrutha. Hence the term Sirajadushtavrana can be attributed to venous ulcer. Aetiopathogenesis of venous ulcer has striking similarities with that of Dushtavrana. In this article, a gentle attempt has been made to correlate the aetiopathogenesis of venous ulcer with the specific characteristics said in each stage of Shadkriyakala (aetiopathogenesis) of Vranasamprapthi (ulcer) as told by Acharya.

Acral Amelanotic Melanoma Mimicking a Non-Healing Arterial Ulcer

Acral melanomas contribute to approximately 2–3% of melanomas but are commonly misdiagnosed due to their rarity, subtlety at onset and tendency to display amelanotic features. This case report describes a 70-year-old male with an amelanotic melanoma misdiagnosed as a non-healing arterial ulcer. Histopathology demonstrated a Breslow 2.3 mm, Clark level IV acral lentiginous melanoma, which was definitively managed with surgical intervention. This case report highlights the importance of considering melanoma in the differential diagnosis of non-healing ulcers.

Management of Chronic Wounds

Chronic wounds are challenging for both the practitioner and the patient. These wounds often cause pain and lead to unemployment, social activity disruption, and quality of life issues for the patient. As the world population advances in age and increases in body mass index, there has been an increase in diabetes and venous insufficiency, ultimately resulting in a rise in the number of patients with chronic wounds. This review covers disease definition, wound-healing necessities, treatment options for management of chronic wounds, special wound care considerations, and investigational therapies. Figures show distribution of chronic wound etiologies, vacuum-assisted closure treatment of chronic wounds, chronic arterial ulcer of the medial foot, a step-wise application of a multilayer compression dressing, and four stages of pressure ulcers. Tables list known causes of tissue hypoxia, types of débridement, common dressings used in chronic wounds, and stages of a pressure ulcer. This review contains 5 highly rendered figures, 4 tables, and 99 references

Management of Chronic Wounds

Chronic wounds are challenging for both the practitioner and the patient. These wounds often cause pain and lead to unemployment, social activity disruption, and quality of life issues for the patient. As the world population advances in age and increases in body mass index, there has been an increase in diabetes and venous insufficiency, ultimately resulting in a rise in the number of patients with chronic wounds. This review covers disease definition, wound-healing necessities, treatment options for management of chronic wounds, special wound care considerations, and investigational therapies. Figures show distribution of chronic wound etiologies, vacuum-assisted closure treatment of chronic wounds, chronic arterial ulcer of the medial foot, a step-wise application of a multilayer compression dressing, and four stages of pressure ulcers. Tables list known causes of tissue hypoxia, types of débridement, common dressings used in chronic wounds, and stages of a pressure ulcer. This review contains 5 highly rendered figures, 4 tables, and 99 references

Validation of the disease-specific quality of life Wuerzburg Wound Score in patients with chronic leg ulcer

Background: Aim of the study was to validate a newly developed disease-specific quality of life questionnaire (Wuerzburg Wound Score, WWS) in patients with chronic arterial or venous leg ulcers. Patients and methods: In this prospective study 115 patients with vascular disease associated leg ulcer (54 arterial ulcer, 61 venous ulcer) were studied (mean age 66 ± 11 years, 51 % male). All patients completed the WWS at baseline, and after four and 12 weeks. To assess construct validity additionally all patients completed the generic QoL-questionnaires Short Form-36 (SF-36) and Nottingham Health Profile (NHP). Construct validity and responsiveness of the WWS were tested. Results: WWS showed acceptable construct validity versus SF-36 (r = 0.5 - 0.78; P < 0.001) and NHP (r = 0.36 - 0.68; P < 0.001). Responsiveness of the WWS was superior to SF-36 (P < 0.05) and NHP (P = 0.01). Generic as well as disease-specific QoL were more impaired in patients with arterial ulcer. Conclusions: The WWS is a valid measure of disease-specific QoL in patients with leg ulcers and it is more sensitive than the generic instruments in detecting changes of wound healing over time. Further assessment of the psychometric properties of the WWS with larger patient samples is required before the test can be recommended for use in clinical practice.